E-Cigarette Use among High School Students Dropped in 2023, but More Work is Needed

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A new report released by the US Food and Drug Administration (FDA) and US Centers for Disease Control and Prevention (CDC) shows that 10% of middle and high school students in the US report current use of a tobacco product, although use fell among high schoolers over the past year, potentially due to a drop in e-cigarette use.¹

The study—based on findings from the 2023 National Youth Tobacco Survey of middle school students (grades 6-8) and high school students (grades 9-12)—describes ever use (ie, ever having used, even 1-2 times) and current (ie, past-30 day) use of 9 tobacco product types, flavored tobacco products, and e-cigarette use behaviors.¹

According to authors, the decline in current overall tobacco product use among high school students during 2022-2023 (16.5% to 12.6%) was primarily attributable to a reduction in e-cigarette use (14.1% to 10%). Researchers also noted decreases in current use of cigars and overall combustible tobacco smoking.¹

“It’s encouraging to see this substantial decline in e-cigarette use among high schoolers within the past year, which is a win for public health,” said Brian King, PhD, MPH, director, Center for Tobacco Products, FDA, in an agency press release. “But we can’t rest on our laurels. There’s more work to be done to build on this progress.”²

Despite fewer high school students reporting current use of a tobacco product, authors of the report found statistically significant increases among middle school students during 2022-2023 in current use of at least 1 tobacco product (4.5% to 6.6%; P<.05) and in use of multiple tobacco products (1.5% to 2.5%).Among middle school students overall, however, investigators did not observe a significant change during 2022-2023 for current use of any individual tobacco product type, including e-cigarettes.¹

For the 10th consecutive year, e-cigarettes were the most commonly used tobacco product among both high school (10%) and middle school (4.6%) students. Other currently used tobacco products among both middle school and high school studentsin 2023 were cigarettes (1.6%), cigars (1.6%), nicotine pouches (1.5%), smokeless tobacco (1.2%), other oral nicotine products (1.2%), hookah (1.1%), heated tobacco products (1.0%), and pipe tobacco (0.5%).¹

In addition, among all students who had ever used e-cigarettes, 46.7% reported current e-cigarette use in 2023. Furthermore, among those who reported current e-cigarette use, 25.2% said they used them daily. Frequent use, defined as ≥20 of the past 30 days, was reported by 34.7% of current e-cigarette users, according to the report.¹

Most (89.4%) of middle school and high school students who currently used e-cigarettes reported using flavored products such as Elf Bar (56.7%), Esco Bars (21.6%), Vuse (20.7%), JUUL (16.5%), and Mr. Fog (13.6%).¹

“A continued comprehensive approach to tobacco use prevention is needed to further reduce tobacco use among youths, based on knowledge about youth product use behaviors,” wrote researchers. “Further, longstanding and proven tobacco prevention policies, such as price increases, comprehensive smoke-free policies (that include e-cigarettes), counter-marketing campaigns, and health care intervention, will continue to reduce youth initiation and tobacco use.”¹

References:

1. Birdsey J, Cornelius M, Jamal A, et al. Tobacco product use among US middle and high school students — National Youth Tobacco Survey, 2023. MMWR. 2023;72:1173-1182

2. National survey shows drop in e-cigarette use among high school students. News release. FDA. November 2, 2023. Accessed November 6, 2023. https://www.fda.gov/news-events/press-announcements/national-survey-shows-drop-e-cigarette-use-among-high-school-students